Background

Dizziness is a vague and nonspecific symptom. It refers to an abnormal sensation in relation to space and position. Vertigo is a specific type of dizziness that is defined as a spinning or rotatory sensation. Patients with vertigo report that things are rotating around them or that they are rotating around things.

Vertigo could be either from a peripheral (labyrinth and vestibular nerve) or a central disorder (central nervous system). Central vertigo is usually a result of an abnormal processing of the vestibular sensory input by the central nervous system.

See the image below.

Electrode montage for electronystagmography (ENG) testing.

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Pathophysiology

The sensation of balance is the result of appropriate information detected by the vestibular, ocular, and proprioceptive sensory receptors that is then properly integrated within the cerebellum and brain stem. Proper gait, posture, and visual focus during head movement all depend on an intact sense of balance. Loss of sensory information, central integration, and output control mechanisms all result in a sense of imbalance.

Central causes of vertigo result from either a disruption of central integrators (ie, brain stem, cerebellum) or a sensory information mismatch (ie, from the cortex). Lesions that affect the vestibular nerve or root entry zone (ie, cerebellopontine angle [CPA] lesions) result in imbalance by affecting primary vestibular sensory information.

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Epidemiology

Race

No racial predilection exists for CNS causes of vertigo.

Sex

Men and women are affected differently by different causes of CNS vertigo. Vestibular migraine (migraine-related vertigo, or migrainous vertigo), for example, shows a predilection for women.

Age

CNS causes of vertigo typically affect older population groups because of the associated risk factors of vascular causes of vertigo, such as hypertension, atherosclerosis, and diabetes mellitus.
[1]

Younger population groups are more commonly affected by migraine headaches and multiple sclerosis (MS).
[2] Cerebellar tumors affect a bimodal population of children and adults. CPA tumors typically affect people in the fifth to eighth decades of life.

A study by Teggi et al involving 252 patients with vestibular migraine found the ages of onset for migraine and vertigo to be 23 years and 38 years, respectively, in this group. Onset of migraine tended to occur at a lower age in patients with a family history of migraine, while the age of vertigo onset tended to be lower in patients with a childhood history of benign paroxysmal vertigo, benign paroxysmal torticollis, and motion sickness.
[3]

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.